A hospital-based retrospective study: early recognition of neuronal surface antibodies by clinical manifestations and CSF inflammation indicators in patients with unexplained epilepsy

Abstract

Background

There is a lack of actual and comprehensive data on the detection rate of neuronal surface antibodies in patients with unexplained epilepsy in China. Thus, we attempted to analyze the differences in clinical manifestations, cerebrospinal fluid (CSF) characteristics, seizure types and other aspects of antibody-positive and negative patients, to identify suspected antibody-positive epilepsy patients.

Methods

In total, 137 inpatients with unexplained epilepsy were consecutively included, and neuronal surface antibodies (NSAbs) were detected by serological and/or CSF evaluations. The clinical features and seizure characteristics were analyzed between the NSAb-positive and negative patients. In addition, patients were divided into four groups based on CSF and blood antibody titers. CSF cell count and protein content were analyzed in relation to antibody titers.

Results

There were 45 (32.8%) patients tested positive for antibodies. Multivariate analyses revealed that age, mental status changes or memory deterioration, CSF protein, CSF cell count, treatment, days of hospitalization, outcome, duration of symptoms before hospitalization, status epilepticus, and number of antiepileptic drugs were significantly associated with the NSAb-positive group and changes in inflammatory indicators in routine CSF analysis were associated with antibody titers.

Conclusions

A relatively high proportion of patients with unexplained epilepsy have positive NSAbs. Patients with the above clinical characteristics need to be highly suspected of NSAbs positivity and should be tested for antibodies in time to assist treatment. The decrease of CSF cell count and protein content has suggestive value for the decrease of antibody titer, which should be evaluated in the follow-up.

Keywords:

• Epilepsy
• neuronal surface antibodies
• inflammatory indicators
• antibody titer levels
• retrospective study

Acknowledgment

We thank all participating patients.

Author contributions

DSQ conceived the study and drafted the article. WJP collected clinical data, and interpreted data. YFF performed statistical analyses, transforming raw data into figures and tables, and compiled references. HYC contributed to the writing of successive versions of the manuscript. The rest of the authors contributed with clinical assessment, data acquisition, analysis, diagnosis, and critical revision of the article.

Ethics approval and consent to participate

The Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University approved this study (No. 2019-ky-69).

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Deidentified study data will be made available upon request.

Additional information

Funding

This work was supported by the Research Fund of Yiwu Science and Technology under Grant number 22-3-26.